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A1? *-, 2eT- <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Grand County <br />M-1995-004 <br />Inspiration Point <br />May 5, 2009 <br />$791.00 (Due on or before your anniversary date) <br />Grand <br /> <br />APR 2 1, 2009 t/ <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />operator shall submit the-annual fee, -a report-and map-showing-the-extent- of-current-disturbances -to-affected-- <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during tWe upcoming-year,- reclam`atiori that-will-be" performed during-the coming yeare dates^for t lI e____ - <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new chances to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Ken Haynes <br />Permittee Name: Grand County <br />Address: 467 E. Topaz Ave. <br />P.O. Box 9 <br />Granby, CO 80446 <br />Phone Number: (970) 887-2123 <br />Fax Number: (970) 887-3168 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it o this form along with your written report and map. Annual Report instructions are <br />enclose . <br />Signature of Corpora fficer, Owner, or Designee <br />'l/La/Z'00!? <br />Date <br />M: \PERMITIMAS TERDOCLJN=S\M-AF-04